Non-resection management of intestinal perforation associated with neutropenic enterocolitis in adolescent leukemia

Abstract

Background: Neutropenic enterocolitis (NE) is a necrotizing inflammatory disease of the cecum or colon that develops during severe neutropenia. We present a leukemic patient who developed multiple intestinal perforations associated with NE and recovered by surgical intervention without bowel resection. Case presentation: A 16-year-old girl was diagnosed with acute lymphoblastic leukemia. During induction therapy, she had been developing severe neutropenia and started to complain of abdominal pain. On day 36, she was experiencing severe abdominal pain with distention, and computed tomography showed abdominal free air and the thickened cecum wall. Emergency surgery revealed multiple perforations on the cecum with patchy necrosis. Abdominal drainage by tube-cecostomy and ileostomy were performed, and the patient gradually recovered. Two months later, the affected cecum was found recovered on second surgery, the ileostomy was closed, and the cecostomy was removed. Eight months after the first surgery, the patient was discharged after maintenance therapy. Conclusions: NE must be suspected in neutropenic patients with abdominal pain. In cases presenting severe complications such as intestinal perforation, abdominal drainage with ostomy can be a promising and minimally invasive option which may contribute to the bowel salvage and avoiding unnecessary bowel resection.

Keywords

• Neutropenic enterocolitis
• Acute lymphoblastic leukemia
• Intestinal perforation